Top Tips to Streamline Your Healthcare Revenue Cycle Management

Revenue Cycle Management is the key to any business’s success as it helps optimise revenues and expenses. This cycle in the health care industry is more complex and prolonged than any other business segment. The entire process is driven by the time consumed and the efficiency of the workflow. In the healthcare industry, three parties are usually involved in the revenue cycle management process. Insurance payments do not cover the entire process of medical treatment. 

The healthcare provider must coordinate with the patients to collect the remainder of the payments after the reimbursements by the insurance companies. The most crucial role in the revenue cycle management process is played by the front desk of hospitals and healthcare facilities which are empowered to register the patients, collect payment details, coordinate with the insurance providers to receive the reimbursements, etc.

Critical Prerequisites for Improving Healthcare Revenue Cycle Management

Strengthening the data acquisition at the front desk

• Enhancing the data registration process to ensure accurate and reliable data: Whether a patient registers over the phone or physically in the hospital, the patient data entered should be accurate and reliable. All the required details from the billing perspective should be entered into the information system. Details recorded should include the first and last name of the patient, the address, and the telephone number.
• Eligibility of the patient and the extent of the coverage by the insurance company: The front desk should examine the validity of the insurance coverage, the time of the range, types of illnesses covered, etc. If the patient is not covered or has full coverage under the insurance plan, we must educate the patients about their treatment options, amounts payable, and payment options. Verifying the validity is one of the essential steps in optimising revenue cycle management. A healthcare revenue cycle management system will help conduct prompt insurance eligibility verification. Pre-authorisation by the insurance companies: We can request pre-authorisation by the insurance companies and ensure that payments are made to prevent non-payment, or lower payments do not occur. All insurance companies may not follow the pre-authorisation procedure. Also, if there are likely short payments, we should apprise the patients upfront, so there are no unpleasant surprises.

Automating the patient appointment schedule 

• Automated systems will help to avoid the risk of manual errors and enable proper scheduling and patient reminders. Healthcare revenue cycle management services aid in this process as the patient details and medical history are automatically updated online. Manual entry is prone to human errors that might affect insurance claims processing. Automated reminders sent to patients will also ensure that patients will reach the clinic on the correct dates and times for their medical treatment and avoid missing doctor appointments. This also helps to increase patient satisfaction. All follow-up visits and rescheduling of patient appointments are better handled this way.
• It is always better to store the credit card information and insurance card details at the time of registration. This avoids wastage of time and allows the hospital to claim unpaid treatments by using this card with the patient’s consent. 
• An advanced cloud-based data management system will enable safe storage and retrieval of medical records and patient details. This enables seamless processing of invoices and management of billing systems.
• Billing software can help to generate electronic claims for insurance companies who prefer documentation sent by digital means.

Improved billing and medical transcription practices

• Front and back office staff must be educated and trained in billing and medical transcription practices.
• They should also be conversant with the insurance companies’ practices to ensure prompt claims processing. 
• Employing a healthcare revenue cycle management service will ensure that our billing and insurance claim filing procedures are up-to-date and help in receipt of prompt payments to optimise the revenue cycle.
• Regular billing and claim processing audits will further help optimise this process.

Tracking of medical insurance claims and denial management

• The last steps include checking and avoiding errors and omissions before submitting claims. All the details in the patient’s medical files and the treatment plan should validate the insurance claim for actual treatments. They will corroborate and provide proof of the patient’s treatments, expediting the fast processing of insurance claims.
• A healthcare revenue cycle management system will also help us to track and follow up on denied claims. 

Key Takeaways 

 A hospital or a healthcare facility is better served by outsourcing the revenue cycle management and focusing exclusively on patient care. These administrative tasks are better performed by professionals experienced in this field. 

This will ensure seamless and effective revenue cycle management. Healthcare revenue cycle management systems can be customised to our specific needs and come in cost-effective packages. This can provide a fast turnaround of patient claims and introduce higher performance standards within our hospital or healthcare organisation. Any gaps in the workflow process within the hospital can also be identified, and steps can be taken to improve them.